Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life.

Background/Objectives: The vestibular labyrinth is classically viewed as a sensor of low-frequency head motion—linear acceleration for the otoliths and angular velocity/acceleration for the semicircular canals. However, there is now substantial evidence that air-conducted sound (ACS) can also activate vestibular receptors and afferents in mammals and other vertebrates. This sound sensitivity underlies sound-evoked vestibular-evoked myogenic potentials (VEMPs), sound-induced eye movements, and several clinical phenomena in third-window pathologies. The cellular and biophysical mechanisms by which a pressure wave in the cochlear fluids is transformed into a vestibular neural signal remain incompletely integrated into a single framework. This study aimed to provide a narrative synthesis of how ACS activates the vestibular labyrinth, with emphasis on (1) the anatomical and biophysical specializations of the maculae and cristae, (2) the dual-channel organization of vestibular hair cells and afferents, and (3) the encoding of fast, jerk-rich acoustic transients by irregular, striolar/central afferents. Methods: We integrate experimental evidence from single-unit recordings in animals, in vitro hair cell and calyx physiology, anatomical studies of macular structure, and human clinical data on sound-evoked VEMPs and sound-induced eye movements. Key concepts from vestibular cellular neurophysiology and from the physics of sinusoidal motion (displacement, velocity, acceleration, jerk) are combined into a unified interpretative scheme. Results: ACS transmitted through the middle ear generates pressure waves in the perilymph and endolymph not only in the cochlea but also in vestibular compartments. These waves produce local fluid particle motions and pressure gradients that can deflect hair bundles in selected regions of the otolith maculae and canal cristae. Irregular afferents innervating type I hair cells in the striola (maculae) and central zones (cristae) exhibit phase locking to ACS up to at least 1–2 kHz, with much lower thresholds than regular afferents. Cellular and synaptic specializations—transducer adaptation, low-voltage-activated K+ conductances (KLV), fast quantal and non-quantal transmission, and afferent spike-generator properties—implement effective high-pass filtering and phase lead, making these pathways particularly sensitive to rapid changes in acceleration, i.e., mechanical jerk, rather than to slowly varying displacement or acceleration. Clinically, short-rise-time ACS stimuli (clicks and brief tone bursts) elicit robust cervical and ocular VEMPs with clear thresholds and input–output relationships, reflecting the recruitment of these jerk-sensitive utricular and saccular pathways. Sound-induced eye movements and nystagmus in third-window syndromes similarly reflect abnormally enhanced access of ACS-generated pressure waves to canal and otolith receptors. Conclusions: The vestibular labyrinth does not merely “tolerate” air-conducted sound as a spill-over from cochlear mechanics; it contains a dedicated high-frequency, transient-sensitive channel—dominated by type I hair cells and irregular afferents—that is well suited to encoding jerk-rich acoustic events. We propose that ACS-evoked vestibular responses, including VEMPs, are best interpreted within a dual-channel framework in which (1) regular, extrastriolar/peripheral pathways encode sustained head motion and low-frequency acceleration, while (2) irregular, striolar/central pathways encode fast, sound-driven transients distinguished by high jerk, steep onset, and precise spike timing.

Background: Paragangliomas of the head and neck are rare, benign and indolent to slow-growing tumors. Not all tumors require immediate active intervention, and surveillance is a viable management strategy in a large proportion of cases. Treatment decisions are based on several tumor- and patient-related factors, with the tumor progression rate being a predominant determinant. Accurate prediction of tumor progression has the potential to significantly improve treatment decisions by helping to identify patients who are likely to require active treatment in the future. It furthermore enables better-informed timing for follow-up, allowing early intervention for those who will ultimately need it, and optimization of the use of resources (such as MRI scans). Crucial to this is having reliable estimates of the uncertainty associated with a future growth forecast, so that this can be taken into account in the decision-making process. Methods: For various tumor growth prediction models, two methods for uncertainty estimation were compared: a historical-based one and a Bayesian one. We also investigated how incorporating either tumor-specific or general estimates of auto-segmentation uncertainty impacts the results of growth prediction. The performance of the uncertainty estimates was examined both from a technical and a practical perspective. Study design: Method comparison study. Results: Data of 208 patients were used, comprising 311 paragangliomas and 1501 volume measurements, resulting in 2547 tumor growth predictions (a median of 10 predictions per tumor). As expected, the uncertainty increased with the length of the prediction horizon and decreased with the inclusion of more tumor measurement data in the prediction model. The historical method resulted in estimated confidence intervals where the actual value fell within the estimated 95% confidence interval 94% of the time. However, this method resulted in confidence intervals that were too wide to be clinically useful (often over 200% of the predicted volume), and showed poor ability to differentiate growing and stable tumors. The estimated confidence intervals of the Bayesian method were much narrower. However, the 95% credible intervals were too narrow, with the true tumor volume falling within them only 78% of the time, indicating underestimation of uncertainty and insufficient calibration. Despite this, the Bayesian method showed markedly better ability to distinguishing between growing and stable tumors, which has arguably the most practical value. When combining all growth models, the Bayesian method using tumor-specific auto-segmentation uncertainties resulted in an 86% correct classification of growing and non-growing tumors. Conclusions: Of the methods evaluated for predicting paraganglioma progression, the Bayesian method is the most useful in the considered context, because it shows the best ability to discriminate between growing and non-growing tumors. To determine how these methods could be used and what their value is for patients, they should be further evaluated in a clinical setting.

Background: Narrow duplicated internal auditory canal (IAC) is a rare congenital malformation frequently associated with severe-to-profound sensorineural hearing loss. Case Presentation: We present a one-year-old girl with bilateral narrow duplicated IAC and profound hearing loss evaluated through CT/MRI and electrically evoked auditory brainstem response (EABR). Methods: We conducted a systematic review (1990–2023), identifying 59 published cases of which 24 were bilateral. The mean age at diagnosis was 10.34 years, and 25 cases presented additional inner ear malformations. Only seven patients underwent cochlear implantation, and EABR was performed in four cases. Outcomes of cochlear implantation were heterogeneous. Discussion: In our case, EABR showed a reproducible wave V on the right side, supporting candidacy for cochlear implantation which led to positive early auditory responses. Conclusions: This case and review highlight the role of EABR in identifying residual cochlear nerve functionality and guiding candidacy for cochlear implantation in narrow duplicated IAC.

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an abrupt unilateral hearing loss of unknown origin. Combination therapy with hyperbaric oxygen (HBO), systemic steroids (SS), and prostaglandin E1 (PGE1) has been used in Japan; however, its prognostic factors remain unclear. Objective: To evaluate the efficacy of HBO combined with SS and PGE1 and to identify prognostic factors for hearing recovery in patients with ISSNHL. Methods: This retrospective study included 116 patients treated within 14 days of ISSNHL onset. Sixty patients received HBO, SS, and PGE1 (HBO group), and 56 received SS and PGE1 alone (No-HBO group). Hearing outcomes were assessed using PTA (arithmetic mean hearing at 250–4000 Hz) and graded by Siegel’s criteria. Prognostic factors were analyzed by multivariate logistic regression. Results: The HBO group showed significantly better hearing grade outcomes (p = 0.007) and greater PTA improvement (p = 0.003) than the No-HBO group. Vertigo and higher initial PTA were identified as independent predictors of poor hearing outcomes. Patients without vertigo showed significantly greater improvement at 2000 Hz (p = 0.009). Receiver operating characteristic analysis revealed an optimal initial PTA cutoff of ≥90.5 dB for predicting poor hearing outcome. Conclusions: HBO combined with SS and PGE1 significantly improves hearing outcomes in ISSNHL. However, the presence of vertigo and severe initial hearing loss remain poor prognostic indicators. These findings suggest that while the addition of HBO may enhance hearing outcomes, prognosis remains limited in severe cases. Further prospective studies are needed to confirm these results.

Background/Objectives: This narrative review aims to evaluate the use of pupillometry as an objective measure of auditory perception and listening effort across the lifespan. Specifically, it synthesizes research examining pupillary responses in individuals with and without hearing impairment across pediatric, adult, and older adult populations. The review addresses methodological practices and clinical implications for integrating pupillometry into routine audiological assessment. Methods: 12 peer-reviewed studies published between 2010 and 2025 were selected through a systematic search of databases including PubMed, Scopus, Web of Science, and Google Scholar. Inclusion criteria required empirical use of pupillometry in auditory tasks involving human participants with normal hearing or hearing impairment. Studies were analyzed for population characteristics, experimental paradigms, pupillometric metrics (e.g., peak pupil dilation), level of evidence, and relevance to clinical audiology. This article uses a narrative review approach to organize and interpret findings. Results: Across age groups and hearing conditions, pupillometry consistently demonstrated sensitivity to cognitive load and listening effort, particularly in noisy environments or during complex auditory tasks. Pediatric studies revealed its potential as a non-invasive tool for preverbal children. Adult and older adult studies confirmed that pupillary responses reflect device performance (e.g., hearing aids, cochlear implants) and cognitive–linguistic demands. Methodological variability and individual differences in pupil response patterns were noted as limitations. Conclusions: The findings support the use of pupillometry as a valuable adjunct to behavioral audiometry, offering objective insight into auditory–cognitive load. Its application holds promise for pediatric diagnostics, hearing technology evaluation, and geriatric audiology. Standardization of measurement protocols and development of normative data are necessary to enhance clinical applicability and generalizability.

Background and Objectives: Speech-in-noise testing is essential for evaluating functional hearing abilities in clinical practice. Although the Quick Speech-in-Noise test (QuickSIN) is widely used, no equivalent tool existed for European Portuguese. This study aimed to develop a Speech-in-Noise Test for European Portuguese (SiN-EP), linguistically adapted and calibrated for native speakers, to support clinical assessment of speech perception in realistic listening environments. Materials and Methods: The SiN-EP was developed through a multi-stage process. Sentences were drafted to reflect natural speech patterns and reviewed by native speakers for clarity and grammatical accuracy. Selected sentences were recorded by a female native speaker in a controlled acoustic environment and mixed with multi-talker babble at signal-to-noise ratios (SNR (dB)) from 25 to 0 SNR (dB). A pre-test in a free-field setting at 65 dB SPL was conducted with fifteen normal-hearing young adults. Participants repeated each sentence, and their responses were analyzed to refine list composition, adjust difficulty, and ensure phonetic balance. Results: Intelligibility decreased systematically as SNR (dB) worsened, with ceiling effects at 25 and 20 SNR (dB). At 5 SNR (dB), high variability was observed, with set 5 showing disproportionate difficulty and set 14 containing an incomplete sentence; both were removed. At 0 SNR (dB), all sets demonstrated expected low intelligibility. The final test comprises thirteen lists of six sentences, each maintaining stable intelligibility, phonetic representativeness, and consistent difficulty across SNRs (dB). Conclusions: The SiN-EP provides a linguistically appropriate, phonetically balanced, and SNR (dB) calibrated instrument for assessing speech-in-noise perception in European Portuguese. The refinement process improved reliability and list equivalence, supporting the test’s clinical and research applicability. The SiN-EP fills a critical gap in assessing speech-in-noise perception in European Portuguese speakers, providing a reliable tool for both clinical and research applications.

Background and Clinical Significance: Otitis media with effusion (OME) is characterized by persistent middle ear effusion without acute infection. Type 2 inflammation, mediated by IL-4 and IL-13 signaling via the IL-4Rα receptor, has been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and possibly OME. Refractory OME in adults remains a therapeutic challenge, as conventional treatments often fail to achieve long-term resolution. Targeted biologic therapies that modulate type 2 inflammation may offer a novel treatment option. Case Presentation: We report the case of a 60-year-old man with a 15-year history of allergic rhinitis and CRSwNP, complicated by recurrent asthma exacerbations, who presented with bilateral aural fullness, hearing loss, and tinnitus. His symptoms persisted despite repeated tympanic punctures, Eustachian tube insufflation, and corticosteroid therapy. Otoscopy revealed dull tympanic membranes with effusion, and audiometry showed conductive hearing loss with a B-type tympanogram on the left. Laboratory findings demonstrated mild peripheral eosinophilia. The patient was diagnosed with OME, likely secondary to type 2 inflammation. After nine biweekly injections of Stapokibart (CM310)—a humanized monoclonal antibody targeting IL-4Rα—aural fullness completely resolved. Otoscopic findings and tympanograms normalized, and hearing thresholds improved significantly. Retrospective evaluation using Iino’s diagnostic framework suggested that the patient did not meet the full criteria for eosinophilic otitis media (EOM); nevertheless, marked symptomatic and functional improvement was achieved. No recurrence or adverse effects were observed during follow-up. Conclusions: This case suggests that IL-4Rα blockade with Stapokibart may be effective in treating refractory OME associated with type 2 inflammation, even in patients who do not fulfill the diagnostic criteria for EOM. These findings highlight the potential of anti-IL-4Rα biologics as a novel therapeutic option for middle ear diseases driven by type 2 inflammation.

Background/Objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification of ligaments and tendons, primarily affecting the spine. While often asymptomatic, DISH in the cervical spine can cause dysphagia and, more rarely, vocal cord paralysis due to compression of the recurrent laryngeal nerve at the cricothyroid joint. Here, we report cases of unilateral vocal fold paresis in two patients with DISH. Case Presentation: Our first case is an 80-year-old male presented with two months of dysphonia. Strobovideolaryngoscopy found left vocal fold paresis with glottic insufficiency. Computed Tomography (CT) imaging showed DISH with large anteriorly projecting osteophytes in the cervical spine causing rightward deviation of the laryngeal structures and compressing the cricothyroid joint. Second, a 30-year-old female with Turner Syndrome and subglottic stenosis who developed progressively worsening dysphonia over 6 months, characterized by diminished voice projection and clarity. Strobovideolaryngoscopy revealed a mild-to-moderate right vocal fold paresis. CT of the neck demonstrated multiple right-sided osteophytes projecting into the right tracheoesophageal groove, along the course of the right recurrent laryngeal nerve, in the absence of significant disc degeneration. Discussion and Conclusions: On our review of the literature, no other similar instances of unilateral vocal fold paresis were found. We present these cases to emphasize the need for early recognition and treatment to prevent symptom progression of DISH.

Background/Objectives: Head and neck cancers significantly affect patients’ functional and psychosocial well-being. Multidisciplinary tumor boards have a central role in optimizing treatment strategies, but the relationship between tumor characteristics, comorbidities, and quality of life (QoL) remains insufficiently explored. Methods: We conducted a retrospective study of 94 patients with head and neck cancers evaluated by the oncology committee of Coltea Clinical Hospital in 2024. QoL was assessed post-surgery using the EORTC QLQ-C30 and H&N35 questionnaires. Descriptive statistics, non-parametric tests, correlations, and multivariate regression analyses were performed to examine associations between clinical variables and QoL outcomes. Results: The cohort comprised 82 men (87.2%) and 12 women (12.8%), with a mean age of 61.5 ± 9.8 years. The most common tumor site was the larynx (43.6%). Global QoL was low (mean = 42.3, SD = 11.7), and fatigue scores were high (mean = 61.5, SD = 13.5). All EORTC domains showed non-normal distributions (Shapiro–Wilk, p < 0.05). Kruskal–Wallis analysis revealed significantly lower QoL scores in patients with metastatic adenopathy with aunknown primary (p = 0.03). Spearman’s correlation indicated a moderate negative association between Charlson Comorbidity Index and QoL (r = −0.38, p = 0.01). Multivariate regression confirmed comorbidities (β = −2.5, p = 0.02) and tumor type (metastatic adenopathy, β = −8.0, p = 0.04) as independent predictors of reduced QoL. Conclusions: Patients with advanced disease and higher comorbidity burden experience significantly poorer QoL after head and neck cancer surgery. Tumor board decisions facilitate individualized treatment planning; however, systematic integration of QoL metrics is essential to optimize both oncological and functional outcomes.